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Tibial tubercle osteotomies (TTOs) are a versatile procedure that can be used to treat several conditions due to its ability to manipulate both extensor mechanism tracking and patellofemoral joint contact forces. This permits a wide array cut geometries that can be titrated to the individualized needs of each patient. Most common is the anteromedializing (AMZ) TTO, which has been a workhorse procedure for realigning extensor mechanism tracking. The patella can also be distalized, which becomes indicated when pathological patella alta is present. When treating patellar instability, a successful outcome depends on the clinician's understanding of the destabilizing factors. These risk factors are often additive, and if significant enough they can collectively breach a given stability threshold. Three-dimensional models provide a useful perspective of the joint morphology, curvature, and congruency which can be particularly helpful for developing an optimal plan for restoring balanced tracking. To decide when to perform a TTO, the decision centers on how well a TTO provides a solution to a tracking or articular loading problem, compared with the added morbidity that accompanies an osteotomy. Details regarding tubercle anteriorization, medialization and distalization are discussed, along with technical considerations and surgical technique. [ABSTRACT FROM AUTHOR]

Patients with cerebral palsy (CP) are at increased risk for cervical spine pathology. Cervical fusion surgery may be considered in this population, but perioperative outcomes relative to patients without CP remains poorly understood. The purpose of this study was to compare in-hospital complications after cervical fusion in patients with versus without cerebral palsy (CP) using a retrospective cohort design.

Following orthopedic surgery, patients with Parkinson's disease (PD) have been shown to have high rates of surgical complications, and some studies suggest that PD may be associated with greater risk for postoperative medical complications. As complication rates are critical to consider for elective surgery planning, the current study aimed to describe the association of PD with medical complications following anterior cervical discectomy and fusion (ACDF), the most commonly performed procedure to treat cervical degenerative pathology.

Anterior surgical approaches to the cervical spine have allowed for treatment of common and complex pathologies with excellent outcomes. During the approach, complications can result from injury to the surrounding structures. The transverse processes usually protect the vertebral artery (VA) as it enters at C6 and courses cranially through the transverse foramina to C2 (referred to as the V2 segment). This is a case report of a patient who presented with myeloradiculopathy attributed to a C4-C5 disc herniation, severe canal stenosis, and marked bilateral neural foraminal stenosis. Preoperative imaging showed the right VA entering the C4 transverse foramen. This anatomic variant on a routine MRI led to further imaging and precautions when performing an uneventful anterior cervical discectomy and fusion (ACDF) at C4-C5. A high VA entry point into the transverse foramen above C6 could increase the risk of iatrogenic vascular injury in anterior approaches to the cervical spine. Rarely reported, the currently presented case describes a patient with a C4 right VA entry variant and highlights the importance of proper surgical planning.

Case. We report an 11-year-old male who sustained a lesser tuberosity avulsion fracture of the proximal humerus upon making contact with a baseball during an at-bat. This injury was neglected for 14 months and was eventually detected by an axillary radiograph and subsequent MRI. He successfully underwent an open surgical repair and regained full range of motion and level of activity at 1-year follow-up. Conclusion. In pediatric baseball players, lesser tuberosity avulsion fractures may occur upon striking a baseball with a bat. Even after being neglected for several months, these injuries can be treated successfully with an open surgical repair.